Hospice Billing Services for Medicare-Certified Hospices
Hospice billing runs on Medicare’s calendar. The Notice of Election has a deadline counted in days, benefit periods turn over on fixed dates, recertifications need a face-to-face encounter in the right window, and the cap year closes whether or not anyone was watching. All of that happens while your clinical staff are focused on patients at the end of life, which is exactly when dates slip. Our hospice billing services put someone in charge of those dates and keep monthly claims accurate.
What makes hospice billing different
Notice of Election timing
The hospice must file the NOE within five calendar days after the election's effective date. If it's late, the days between the election and the NOE submission are generally the hospice's financial responsibility, unless an exceptional circumstance applies. A Notice of Termination or Revocation is also due within five calendar days of a live discharge or revocation when the final claim hasn't been filed.
Election statements and the addendum
The election statement has required content, including the patient's acknowledgment that hospice care is palliative, the waiver of other Medicare services related to the terminal illness, the effective date and the designated attending physician. Patients can also ask for an addendum listing items, services and drugs the hospice has decided are unrelated to the terminal illness. Missing elements are a common medical review finding.
Four levels of care
Days are billed as routine home care, continuous home care, inpatient respite or general inpatient care, each with its own revenue code and rate. Routine home care pays more for the first 60 days than afterward, and a service intensity add-on may apply for qualifying RN and social worker visits in the last seven days of life. Continuous home care needs at least eight hours of mostly nursing care during a crisis and is billed by the hour. Respite is limited to five consecutive days per stay.
Certification and face-to-face encounters
The benefit runs in two 90-day periods followed by unlimited 60-day periods, and each period needs a certification of terminal illness with a narrative. Before the third period and every one after it, a hospice physician or nurse practitioner must complete a face-to-face encounter within the required window, and the certifying physician has to attest to it. Miss the encounter and days can go uncovered.
The hospice cap
Medicare limits payments through an aggregate cap (an annual per-beneficiary amount times your beneficiary count) and an inpatient cap that limits inpatient days to a share of total days. Hospices with long average stays can exceed the aggregate cap and owe money back. You file your own cap determination with the MAC after each cap year, so tracking it during the year avoids a surprise repayment.
Claim detail, other payers and quality reporting
Monthly claims report visits by discipline, site of service and level-of-care days. Attending physicians who aren't hospice employees bill Part B with the GV modifier, and providers billing unrelated care use GW. Hospice care for Medicare Advantage enrollees is generally billed to Original Medicare, while Medicaid, nursing facility room and board, and commercial benefits have their own rules. Missing Hospice Quality Reporting Program submissions reduces the annual payment update.
Our Services
How Salyx RCM supports hospices
Referral intake
When a referral arrives, we verify eligibility and check prior hospice use, benefit period history, open home health periods and secondary coverage.
NOE and NOTR tracking
Election and discharge dates are tracked and notices are filed on time, provided your team sends us the details promptly.
Coding support
The terminal diagnosis and related conditions on each claim are reviewed against the clinical record by the certified coders on our medical coding staff.
Pre-billing audit
Every monthly claim is checked for election statements, certifications, face-to-face attestations, level-of-care days and visit data before it's released.
Claim submission
Monthly 837I hospice claims are prepared and submitted, and returned claims are corrected and resent.
Payment posting
Medicare, Medicaid and commercial remittances are posted by patient and level of care.
Denials and ADRs
Our denial management team works denials and responds to additional documentation requests.
Credentialing
We handle enrollment with Medicaid and commercial plans and help keep your Medicare enrollment current.
Family communication
The few patient balances hospice can carry are billed with clear statements and a careful tone.
Reporting
You'll see benefit periods coming due, face-to-face encounters needed, cap tracking and AR by payer.
Your hospice EMR
We work in hospice systems like WellSky, Axxess, Homecare Homebase and MatrixCare, and others. Election statements, certifications and visit notes are reviewed where your team already keeps them, with no new software to learn.
How It Works
Our process
1. Discovery call
We review your census, payers, EMR and where billing falls behind.
2. Calendar setup
Tracking for NOEs, benefit periods, face-to-face encounters and the cap year is set up first.
3. Onboarding
A signed Business Associate Agreement comes first, then secure access and pre-billing checklists. Patient and family records are handled under HIPAA-compliant processes.
4. Monthly cycle
Notices, audits, claims, posting and follow-up run on a set schedule.
5. Regular review
Cap tracking, AR and documentation issues are reviewed with your leadership.
Related reading
Home health
If your organization also runs a home health agency, see how we handle home health billing under PDGM.
Hard conversations
Hospice billing involves families as well as payers, which is why we wrote about the human side of revenue cycle management.
Frequently Asked Questions
Questions hospice administrators and billing leads often ask.
1. Do you file Notices of Election for our hospice?
Yes. We track each election date and file the NOE within the five-day window, as long as your intake team gets us the election details in time.
2. Can you bill all four hospice levels of care?
Yes. Routine home care, continuous home care, inpatient respite and general inpatient care are all billed, and we check that documentation supports each level before the claim goes out.
3. Do you track the hospice cap?
Yes. We track aggregate and inpatient cap exposure during the cap year and share it with your leadership so you can plan. Your team remains responsible for the final cap filing.
4. How do you handle face-to-face encounters for recertification?
We keep a calendar of upcoming third and later benefit periods and alert your team before each face-to-face window opens, so encounters and attestations are documented on time.
5. Do you submit HQRP quality data?
Your clinical team owns assessment and quality data. We can track HQRP deadlines and confirm required submissions are on schedule.
Other specialties we serve
Salyx RCM also handles billing for these related specialties.
DME Billing
Written orders, modifiers, capped rentals and resupply.
Infusion Billing
Drug units, NDCs, JW and JZ modifiers and administration codes.
Multi-Specialty Billing
E/M leveling, modifiers and global surgery across departments.
Behavioral Health Billing
Therapy time codes, telehealth, authorizations and carve-out plans.
Talk with our hospice billing team
A late NOE or a missed face-to-face encounter costs money you usually can’t get back. If you’d like help keeping those dates under control, let’s set up a free call. The number is (321) 788-3655, and the email is info@salyxrcm.com.